Mentoring is critical to the success of the patient oriented researcher. Over the prior 5 years, the K-24 has permitted the PI to successfully mentor a number of fellows and trainees in the complex techniques of metabolic and cardiovascular risk assessment in the growing population of HIV patients with metabolic disorders. The goals of the prior grant were achieved, as evidenced by the success of the trainees and their publication record. Importantly, the K-24 has fostered the development of a comprehensive mentoring program, in which motivated trainees are selected, based on their interest in patient oriented research, work habits and ethical standards. A project is selected that is unique and achievable, and significant time is spent by the PI guiding trainees in protocol design, regulatory requirements, acquisition of detailed metabolic techniques, didactic coursework, and funding opportunities. The scientific AIMS of the renewal application are based on a successfully funded R01, investigating: 1) mechanisms of increased CAD risk in HIV patients, and 2) treatment strategies using insulin sensitizing agents and lifestyle modification in this population. In the current proposal it is hypothesized that increased inflammation will contribute to increased carotid intimal medial thickness, and increased coronary calcification in the HIV population. Detailed assessment of body composition, coronary plaques and endothelial disease will be made. Proinflammatory cytokines and indices of inflammation will be measured and related to the development of endothelial dysfunction in longitudinal studies, controlling for traditional risk factors. In the second AIM, a novel lifestyle modification program, based on a highly successful pilot study, will be implemented. HIV-infected subjects with the metabolic syndrome will undergo an intensive lifestyle modification program modeled after the Diabetes Prevention Program. Comparison of lifestyle modification (with a rigorous exercise program) and metformin on fat distribution, inflammatory markers, and carotid IMT will be made. Trainees will be exposed to detailed techniques of body composition assessment and exercise training. Funding for the scientific AIMS has been secured through an NIH R01, and the K-24 is critical to support the Pi's significant time spent in mentoring. The training environment at the Pi's institution is outstanding, in terms of didactic resources and availability of techniques to assess complex metabolic endpoints. Importantly, the PI enjoys the significant support of his Unit and Division Chiefs, who have enthusiastically endorsed his successful mentoring efforts over the prior 5 years of the grant and the plans in the current proposal. Taken together, the proposed K-24 renewal application offers a strong mentoring program in patient oriented research that is based on the teaching of important principles of endocrinology and metabolism. The studies are to be carried out in a population at significantly increased risk for cardiovascular disease and with which the PI has significant expertise.